development and validation of decision rules to guide frequency of monitoring cd4 cell count in hiv-1 infection before starting antiretroviral therapy开发和验证决策规则指导监控hiv - 1感染的cd4细胞计数频率开始抗逆转录病毒治疗.pdfVIP

Development and Validation of Decision Rules to Guide Frequency of Monitoring CD4 Cell Count in HIV-1 Infection before Starting Antiretroviral Therapy 1,3 2 3 1,4 5 Thierry Buclin *, Amalio Telenti , Rafael Perera , Chantal Csajka , Hansjakob Furrer , Jeffrey K. Aronson3, Paul P. Glasziou3 1 Division of Clinical Pharmacology and Toxicology, University Hospital Center and University of Lausanne, Lausanne, Switzerland, 2 Microbiology Institute and Swiss HIV Cohort Study board, University Hospital Center and University of Lausanne, Lausanne, Switzerland, 3 Department of Primary Health Care, Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom, 4 Clinical Pharmacy Unit, Department of Pharmaceutical Sciences, University of Geneva and Lausanne, Lausanne, Switzerland, 5 University Clinic for Infectious Diseases and Swiss HIV Cohort Study Board, University Hospital and University of Bern, Bern, Switzerland Abstract Background: Although CD4 cell count monitoring is used to decide when to start antiretroviral therapy in patients with HIV- 1 infection, there are no evidence-based recommendations regarding its optimal frequency. It is common practice to monitor every 3 to 6 months, often coupled with viral load monitoring. We developed rules to guide frequency of CD4 cell count monitoring in HIV infection before starting antiretroviral therapy, which we validated retrospectively in patients from the Swiss HIV Cohort Study. Methodology/Principal Findings: We built up two prediction rules (‘‘Snap-shot rule’’ for a single sample and ‘‘Track-shot rule’’ for multiple determinations) based on a systematic review of